Fragile hands: targeting nonmelanoma skin cancer on older hands using 595 nm pulsed dye laser.

PURPOSE: The mainstay of treatment for nonmelanoma skin cancer (NMSC) on thin skin remains surgical, but procedures on older hands may be complicated by skin fragility and dermal atrophy. Used without cooling, 595 nm (nm) pulsed dye laser (PDL) has the capability of destroying NMSC through nonspecific thermal necrosis. The purpose of this study was to understand recurrence of NMSC on dorsal hands of older patients after one or two treatments using 595 nm PDL. METHODS: A retrospective chart review identified 147 cases of NMSC located on the dorsal hands treated with 595 nm PDL. Cases of basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) were included. All patients received one to two treatments with PDL. The primary outcome was the recurrence of carcinoma. RESULTS: Among NMSC cases treated with PDL, recurrence occurred in 12 patients (8.2%). No cases of BCC recurred during the study period. Recurrence of SCC was 4.7% for SCC in situ and 10.4% recurrence for invasive SCC (p = 0.34). Among 71 patients treated once, recurrence occurred in 10 patients (14.1%), and among 76 cases treated twice, recurrence occurred in 2 patients (2.6%, p = 0.01). CONCLUSION: Two treatments of PDL for NMSC on the dorsal hands of older patients was well tolerated, had low recurrence, and seemed more effective than one treatment.

Effects of Adverse Childhood Experiences and Chronic Health Conditions on Current Depression.

This study investigated the ability of three adverse childhood experience (ACE) types (household dysfunction, emotional/physical abuse, and sexual abuse) to predict current depression among adults. We also determined the contribution of ACEs to current depression after controlling for covariates and chronic illnesses. Respondents to the 2010 Behavioral Risk Factor Surveillance System (n = 20,345) were divided into depressed and not depressed groups based on Patient Health Questionnaire-8 (PHQ-8) scores. Binary logistic regression determined the ability of ACE exposure to predict depression while controlling for effects of covariates and number of chronic illnesses. Hierarchical multiple linear regression determined the association of ACEs on depression scores after accounting for the covariate set and chronic illnesses. Sexual Abuse had the single strongest association with current depression of any ACE exposure. Exposure to three ACE types has the greatest association with current depression. ACEs accounted for about 7% of the variance in depression scores.

PHQ-8 minor depression among pregnant women: association with somatic symptoms of depression.

It was recently reported that pregnant women were more likely to have minor depression as measured by the Patient Health Questionnaire-8 depression scale (PHQ-8), (as reported by Kroenke and Spitzer (Psychiatr Ann 32(9):1-7, 2002), and Kroenke et al. (J Affect 114(1-3):163-173, 2009)) compared to women who were not pregnant (as reported by Ashley et al. (Arch Womens Ment Health 19(2):395-400, 2015)). The present study is designed to investigate if somatic symptoms (energy level, appetite, sleep) associated with both pregnancy and depression were responsible for this increased prevalence of minor depression. A sample of pregnant women (n = 404) was compared to women who were not pregnant (n = 6754). Both groups scored within the minor depression range on the PHQ-8 and comparisons were based on participants' responses to PHQ-8 items. Results indicate that of the somatic symptoms of depression, only changes in energy level accounted for the elevated prevalence of minor depression among pregnant women compared to women who are not pregnant. Removing the decreased energy item from the score determination reduces the prevalence of minor depression among pregnant women to a level significantly below that of women who are not pregnant. Emotional symptoms such as feeling down and feeling like a failure were less likely to be reported by pregnant women compared to women who were not pregnant. Implications for depression screening during pregnancy are discussed.

Estimated prevalence of antenatal depression in the US population.

The purpose of this study is to determine the prevalence of minor and major depression among pregnant women in the USA. Also, we compare prevalence of depression among pregnant and non-pregnant women while controlling for relevant covariates. A population-representative sample of pregnant women (n = 3010) surveyed for the 2006 Behavioral Risk Factor Surveillance System was compared to a sample of women who were not pregnant (n = 68,620). Binary logistic regression was used to determine prevalence ratios of depression for pregnant and non-pregnant women while controlling for the effects of age, race, annual income, employment status, educational level, marital status, general health, and availability of emotional support. Depression was measured by the Patient Health Questionnaire-8 (PHQ-8). The prevalence of major depression was no greater among pregnant women (6.1%) compared to non-pregnant women (7%; adjusted prevalence ratio (PR) = 1.1, 95% confidence interval (CI) .8 and 1.5). The prevalence of minor depression was greater among pregnant women (16.6%) compared to non-pregnant women (11.4%; adjusted PR = 1.5, 95% CI 1.2 and 1.9). Prevalence ratios are adjusted for the effects of covariates noted above. Prevalence of major depression is not associated with pregnancy, but minor depression is more likely among women who are pregnant.

Complementary and alternative medicine use among people with asthma and health-related quality of life.

OBJECTIVE: This study investigated the relationship between complementary and alternative medicine (CAM) use and self-reported health-related quality of life among people with asthma. METHOD: Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) survey and the 2010 Asthma Callback Survey (ACBS) were used. Survey respondents were men and women with asthma who were 18-99 years of age who responded to both surveys. RESULTS: CAM use was associated with an increase in the number of days of poor mental health (OR = 1.02, 95% CI 1.02, 1.03) and poor physical health (OR = 1.02, 95% CI 1.01, 1.02). The odds ratios are adjusted for covariates such as asthma severity, age, sex, race/ethnicity, income, and educational attainment. CAM users report more days of poor mental health (7.2 versus 4.6) and poor physical health (9.6 versus 6.5) compared with those not using CAM therapies. CONCLUSIONS: Contrary to the hypotheses, CAM use is associated with poorer health-related quality of life. Implications for research and practice are discussed in detail.

Complementary and alternative medicine use and asthma: relation to asthma severity and comorbid chronic disease.

OBJECTIVE: To determine (a) the prevalence of complementary and alternative medicine (CAM) use among people with asthma, and (b) if comorbid chronic disease and asthma severity are associated with CAM use. METHODS: This cross-sectional study utilized data from n = 15 276 adults who participated in the 2009 Behavioral Risk Factor Surveillance System (BRFSS) and the 2009 Asthma Callback Survey (ACBS). Binary Logistic regression was used to determine if comorbid disease and asthma severity were associated with CAM use (yes/no). Model covariates were age, sex, income, and education. RESULTS: About 26% of respondents report using at least one form of CAM. The most frequently reported form of CAM use is breathing exercises (19.8%). The results indicate that neither comorbid cardiovascular disease, diabetes, nor stroke are related to CAM use, but individuals with more severe asthma symptoms were more likely to use CAM (OR = 1.05, 95% CI 1.04, 1.05). CONCLUSIONS: CAM remedies most often reported by people with asthma (breathing techniques, vitamins) are unlikely to pose safety risks. Comorbid chronic disease does not motivate people with asthma to seek unconventional remedies. The increase in CAM use with asthma severity prompts questions about factors that might drive this behavior, such as untreated/inadequately treated disease, or medication side effects.

Classroom friends and very best friends: a short-term longitudinal analysis of relationship quality.

Second-, third-, fifth-, and sixth-grade children evaluated relationship qualities of a self-nominated friend and a self-nominated very best friend over a 6-month school year period. Results demonstrated that 76% of the friend relationships and 50% of the very best friend relationships were maintained over the course of the study. Children in maintained friendships evaluated their relationships more positively and also reported having larger friendship networks in general compared with children whose friendships did not endure over time. Thus those with unstable relationships are having difficulty initiating new friendships as well. For very best friends, positive relationship qualities (e.g., caring) did not change over time for children in maintained relationships, while positive relationship qualities decreased over time for children in nonmaintained relationships. Further, no differences emerged between children in maintained and nonmaintained very best friendships on perceptions of negative relationship qualities (e.g., conflict).

No evidence of seasonal variation in mild forms of depression.

BACKGROUND AND OBJECTIVES: Seasonal Affective Disorder (SAD) is ubiquitous in popular culture and has influenced psychiatric diagnosis with the inclusion of the seasonal pattern modifier for the Major Depressive Episode in DSM. However, recent research has not supported the association of Major Depressive Episode with seasonal changes. The present study was conducted to determine if a seasonally-related pattern of occurrence of mild variants of depression could be demonstrated in a population-based study. METHODS: This is a cross-sectional U.S. survey of adults who completed the PHQ-8 Depression Scale with mild depression defined using a PHQ-8 cut score and a second model based on the DSM-5 diagnosis, Depression with insufficient symptoms. Regression models were used to determine if either variant of mild depression was related to season, latitude, or measures of daylight hours. RESULTS: Neither measure of mild depression was related to daylight hours or its proxy measures. LIMITATIONS: Screening instruments for depression, even if consistent with DSM-5 diagnostic criteria, do not allow a formal diagnosis of depression or the exclusion of similar-appearing disorders. Current depression symptoms but not duration of depressive episode is measured. CONCLUSIONS: Mild depression is not related to seasonal changes or proxy measures of light exposure. The findings cast doubt on light deficiency as a causal factor of depressive disorders, which underpins the inclusion of the seasonal pattern modifier in DSM-5 and light supplementation as a treatment modality.

Does Wechsler Intelligence Scale administration and scoring proficiency improve during assessment training?

Studies have found that Wechsler scale administration and scoring proficiency is not easily attained during graduate training. These findings may be related to methodological issues. Using a single-group repeated measures design, this study documents statistically significant, though modest, error reduction on the WAIS-III and WISC-III during a graduate course in assessment. The study design does not permit the isolation of training factors related to error reduction, or assessment of whether error reduction is a function of mere practice. However, the results do indicate that previous study findings of no or inconsistent improvement in scoring proficiency may have been the result of methodological factors. Implications for teaching individual intelligence testing and further research are discussed.

Decreasing scoring errors on Wechsler Scale Vocabulary, Comprehension, and Similarities subtests: a preliminary study.

Studies of graduate students learning to administer the Wechsler scales have generally shown that training is not associated with the development of scoring proficiency. Many studies report on the reduction of aggregated administration and scoring errors, a strategy that does not highlight the reduction of errors on subtests identified as most prone to error. This study evaluated the development of scoring proficiency specifically on the Wechsler (WISC-IV and WAIS-III) Vocabulary, Comprehension, and Similarities subtests during training by comparing a set of 'early test administrations' to 'later test administrations.' Twelve graduate students enrolled in an intelligence-testing course participated in the study. Scoring errors (e.g., incorrect point assignment) were evaluated on the students' actual practice administration test protocols. Errors on all three subtests declined significantly when scoring errors on 'early' sets of Wechsler scales were compared to those made on 'later' sets. However, correcting these subtest scoring errors did not cause significant changes in subtest scaled scores. Implications for clinical instruction and future research are discussed.

Social integration and life and family satisfaction in survivors of injury at 5 years postinjury.

This study assessed the relationship of social integration (SI) to life satisfaction and family satisfaction among survivors 5 years after injury. Thirty-four matched pairs of injured patients were interviewed by telephone 60 months after initial discharge from the acute care setting. Respondents were matched according to sex, race, education, injury severity, and employment status before comparing high and low socially integrated persons on measures of family and life satisfaction. High and low SI groups were formed based on the Craig Handicap Assessment and Reporting Technique (CHART) SI Scale. The former consisted of patients scoring 100; the latter consisted of patients scoring 50 or less. Analyses of covariance, with age and injury type as covariates, were used to test for group differences. The high and low SI groups differed on both the life and the family satisfaction measures, with the high SI group reporting greater life and family satisfaction.

Life satisfaction following spinal cord injury: long-term follow-up.

OBJECTIVE: To determine the course of self-reported life satisfaction in a spinal cord injury (SCI) cohort. DESIGN: Prospective study using longitudinal data from the Injury Control Research Center. PARTICIPANTS: Adult persons with traumatic-onset SCI (n = 207) evaluated at 1, 2, 4, and 5 years postinjury using the Life Satisfaction Index-A. RESULTS: A nonsignificant (P > 0.05) main effect of time was found using a repeated-measures analysis controlling for education and employment status. Several methods were used that provided a range of liberal to conservative estimates for missing data (ie, 38% retention rate at year 5). Subsequent missing data analyses tended to corroborate the finding of a nonsignificant effect of time, although the most conservative methods showed a significant decrease in life satisfaction between year 1 and year 5 postinjury (P < 0.05). Examination of numerous demographic, injury, and treatment-related characteristics at each follow-up time point suggested that the main findings of the study were not merely the result of differential dropout rates. CONCLUSION: Life satisfaction after the first year of injury remains largely the same over the next 4 years. Methodologic and analytic recommendations are discussed.

The six most essential questions in psychiatric diagnosis: a pluralogue part 3: issues of utility and alternative approaches in psychiatric diagnosis.

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.

The six most essential questions in psychiatric diagnosis: a pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis.

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM--whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.

The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis.

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.

The six most essential questions in psychiatric diagnosis: a pluralogue. Part 4: general conclusion.

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis - the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances' responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first - what is the nature of psychiatric illness - and that in some manner all further questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders - and future nosologies - as far more complex and uncertain than we have imagined.

Emergent endotracheal intubation and mortality in traumatic brain injury.

OBJECTIVES: To determine the relationship between emergent intubation (emergency department and field intubation cases combined) and mortality in patients with traumatic brain injury while controlling for injury severity. METHODS: Retrospective observational study of 981 (35.2% intubated, 64.8% not intubated) patients with TBI evaluating the association between intubation status and mortality. Logistic regression was used to analyze the data. Injury severity measures included Head/Neck Abbreviated Injury Scale (H-AIS), systolic blood pressure, type of head injury (blunt vs. penetrating), and a propensity score combining the effects of several other potential confounding variables. Age was also included in the model. RESULTS: The simple association of emergent endotracheal intubation with death had an odds ratio (OR) of 14.3 (95% CI = 9.4-21.9). The logistic regression model including relevant covariates and a propensity score that adjusted for injury severity and age yielded an OR of 5.9 (95% CI = 3.2-10.9). CONCLUSIONS: This study indicates that emergent intubation is associated with increased risk of death after controlling for a number of injury severity indicators. We discuss the need for optimal paramedic training, and an understanding of the factors that guide patient selection and the decision to intubate in the field.

The reliability and validity of the Life Satisfaction Index-A with survivors of traumatic brain injury.

PRIMARY OBJECTIVE: To investigate the internal consistency, long-term stability and validity of the Life Satisfaction Index-A (LSI-A) in a sample of survivors of traumatic brain injury (TBI). RESEARCH DESIGN: Cohort study. METHODS AND PROCEDURES: LSI-A was administered to survivors of TBI at 12, 24, 48 and 60 months post-injury during telephone interviews. Participants rated their quality of life, independence and participation in activities as well as health status at 24 months. Internal consistency was evaluated with Coefficient alpha. Pearson's r was used to investigate score stability. Test validity was explored with Pearson's r and Analysis of Covariance with age and sex as covariates. EXPERIMENTAL INTERVENTIONS: None. MAIN OUTCOMES AND RESULTS: Coefficient alphas ranged from 0.85-0.92. Test-re-test coefficients ranged from 0.42-0.77. The LSI-A was positively correlated with self-reported quality of life, independence, activity level and health status. CONCLUSIONS: The LSI-A is a reliable and valid measure of the construct of life satisfaction among survivors of TBI.

Reliability and validity of the Family Satisfaction Scale with survivors of traumatic brain injury.

For this study, we investigated the reliability and validity of the FSS (Family Satisfaction Scale) in survivors of traumatic brain injury (TBI). The FSS was administered during the 12- and 60-month follow-up interviews. Data analyses included Cronbach's Alpha to determine internal consistency and analysis of variance to determine the relationship of FSS total score to Life Satisfaction Index-A (LSI-A) total scores, marital status, living arrangement, and number of family contacts outside the home. Cronbach's Alphas were 0.94 (12 months, N = 541) and 0.95 (60 months, N = 340). FSS total score and marital status were significantly related at both 12 months (F(3, 534) = 6.04, p < 0.001) and 60 months postdischarge (F(3, 335) = 4.52, p < 0.005). FSS total scores are correlated with the number of family contacts (r(342) = 0.12, p < 0.03) and with LSI-A total scores (r(337) = 0.43, p < 0.001). The FSS has excellent internal consistency with survivors of TBI. We also demonstrated the evidence of convergent validity.